DESCRIPTION(adapted from applicant's abstract): Several methods have been employed for assessing hearing aid use, benefit, and satisfaction, however, none of these predict hearing aid outcome with confidence. The long term aim of the proposed study is to develop an objective clinical test for predicting hearing aid use. The test is based on the accepted level of background noise when listening to speech delivered at the most comfortable level. The accepted noise level (ANL) is defined as the difference between the level of speech and the level of the background noise that a person is willing to accept when listening to speech without becoming tense and tired while following the words of the story. The ANL should not be convised with speech to noise ratio (S/N) used in speech perception testing. The ANL has been investigated in four preliminary studies with small groups of subjects. The results indicated that the ANL is reliable and stable over a 3-week period and differentiates subjects who wear hearing aids full time from subjects who seldom wear their hearing aids or who reject their hearing aids. The full-time hearing aid users are able to accept significantly higher background noise levels than the other subjects. In the proposed study, a Power Analysis specified cohort of 216 individuals with hearing impairment will be tested. The specific aims are to compare the ANL with traditionally used measures of hearing aid outcome including speech perception in noise and subjective benefit judgments and to determine for the ANL: (1) the ability to predict hearing aid use, (2) dependence upon conditions with and without hearing aids and amplification circuit type, (3) effect of 3-month experience with hearing aids, and (4) dependence upon subjects' gender, age, audiometric sensitivity, and audiometric slope. If the results obtained are consistent with the preliminary findings, the ANL data should predict the actual hearing aid use and help explain the enigma of hearing aid non-compliance in adults with hearing impairment. The prediction of hearing aid use will permit realistic counseling, reduction of false expectations, and possible therapeutic paradigms aimed at increasing acceptance of background noise.